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To assess the extent to which evidence-based practices are regularly used in acute care hospitals in different countries.
Cross-sectional survey study. Participants and setting: Infection preventionists in acute care hospitals in the United States (US), the Netherlands, Switzerland, and Japan.
Data collected from hospital surveys distributed between 2015 and 2017 were evaluated to determine the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central-line–associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). Descriptive statistics were used to examine hospital characteristics and the percentage of hospitals reporting regular use of each infection prevention practice.
Survey response rates were 59% in the United States, 65% in the Netherlands, 77% in Switzerland, and 65% in Japan. Several recommended practices were used in the majority of hospitals: aseptic catheter insertion and maintenance (CAUTI), maximum sterile barrier precautions (CLABSI), semirecumbent patient positioning (VAP), and contact precautions and routine daily cleaning (CDI). Other prevention practices for CAUTI and VAP were used less frequently, particularly in Swiss and Japanese hospitals. Established surveillance systems were also lacking in Dutch, Swiss and Japanese hospitals.
Most hospitals in the United States, the Netherlands, Switzerland, and Japan have adopted certain infection prevention practices. Clear opportunities for reducing HAI risk in hospitals exist across all 4 countries surveyed.
We assessed the long-term sustainability of a quality improvement intervention to reduce urethral catheter use at a Veterans Affairs (VA) hospital. During the 8 years after the initial intervention, point-prevalence surveillance showed that urethral catheter use continued to decrease (OR, 0.91; 95% CI, 0.86–0.97; P = .003) and that appropriateness of catheter use remained unchanged.
We acknowledge and pay respect to the people of the Yugambeh Nation on whose Land we work, meet and study. We recognise the significant role the past and future Elders play in the life of the University and the region. We are mindful that within and without the buildings, the Land always was and always will be Aboriginal Land.1
This paper introduces staying-with the traces of inter/intra-subjective experience, with and within place, in mapping-making philosophy in environmental education. Through a conceptualisation of philosophy as concepts or knots in an infinite composition of knowledge, rather than separate knowledges, we use staying-with the traces2 as method, whereby our embodied patterns of human and more than human relationality across place and time may engage with philosophy. This grounding of philosophy foregrounds the diverse onto-epistemologies of posthumanism and indigenist3 ways of knowing, acknowledging tensions and searching for the possibilities of connectivity between them. Through an embodied arts-based walking practice, our approach challenges the perpetuation of reductionist perspectives, including nature/culture binaries, within environmental education. We stay with the traces of bird, meeting, tree, watery and concrete in mutual inseparable relation and becoming.
To determine clinical consensus and non-consensus in regard to evidence-based statements about feeding infants with complex CHD, with a focus on human milk. Areas of non-consensus may indicate discrepancies between research findings and practice, with consequent variation in feeding management.
Materials and Methods:
A modified Delphi survey validated key feeding topics (round 1), and determined consensus on evidence-based statements (rounds 2 and 3). Patients (n=25) were an interdisciplinary group of clinical experts from across the United States of America. Descriptive analysis used SPSS Statistics (Version 26.0). Thematic analysis of qualitative data provided context for quantitative data.
Round 1 generated 5 key topics (human milk, developing oral feeding skills, clinical feeding practice, growth failure, and parental concern about feeding) and 206 evidence-based statements. The final results included 110 (53.4%) statements of consensus and 96 (46.6%) statements of non-consensus. The 10 statements of greatest consensus strongly supported human milk as the preferred nutrition for infants with complex CHD. Areas of non-consensus included the adequacy of human milk to support growth, need for fortification, safety, and feasibility of direct breastfeeding, issues related to tube feeding, and prevention and treatment of growth failure.
The results demonstrate clinical consensus about the importance of human milk, but reveal a need for best practices in managing a human milk diet for infants with complex CHD. Areas of non-consensus may lead to clinical practice variation. A sensitive approach to these topics is needed to support family caregivers in navigating feeding concerns.
Host–microbial co-metabolism products are being increasingly recognised to play important roles in physiological processes. However, studies undertaking a comprehensive approach to consider host–microbial metabolic relationships remain scarce. Metabolomic analysis yielding detailed information regarding metabolites found in a given biological compartment holds promise for such an approach. This work aimed to explore the associations between host plasma metabolomic signatures and gut microbiota composition in healthy adults of the Milieu Intérieur study. For 846 subjects, gut microbiota composition was profiled through sequencing of the 16S rRNA gene in stools. Metabolomic signatures were generated through proton NMR analysis of plasma. The associations between metabolomic variables and α- and β-diversity indexes and relative taxa abundances were tested using multi-adjusted partial Spearman correlations, permutational ANOVA and multivariate associations with linear models, respectively. A multiple testing correction was applied (Benjamini–Hochberg, 10 % false discovery rate). Microbial richness was negatively associated with lipid-related signals and positively associated with amino acids, choline, creatinine, glucose and citrate (−0·133 ≤ Spearman’s ρ ≤ 0·126). Specific associations between metabolomic signals and abundances of taxa were detected (twenty-five at the genus level and nineteen at the species level): notably, numerous associations were observed for creatinine (positively associated with eleven species and negatively associated with Faecalibacterium prausnitzii). This large-scale population-based study highlights metabolites associated with gut microbial features and provides new insights into the understanding of complex host–gut microbiota metabolic relationships. In particular, our results support the implication of a ‘gut–kidney axis’. More studies providing a detailed exploration of these complex interactions and their implications for host health are needed.
To examine the association between mealtime media use and non-HDL-cholesterol as well as other markers of cardiometabolic risk (CMR) in children.
A repeated measures study design was used to examine the association between mealtime media use and CMR outcomes. Multivariable linear regression with generalised estimating equations was used to examine the association between mealtime media use and CMR outcomes. Analyses were stratified a priori by age groups (1–4 and 5–13 years).
The TARGet Kids! Practice-based research network in Toronto, Canada.
2117 children aged 1–13 years were included in the analysis.
After adjusting for covariates, there was no evidence that total mealtime media use was associated with non-HDL-cholesterol in 1–4 year olds (P = 0·10) or 5–13 year olds (P = 0·29). Each additional meal with media per week was associated with decreased HDL-cholesterol in 5–13 year olds (−0·006 mmol/l; 95 % CI −0·009, −0·002; P = 0·003) and log-TAG in 1–4 year olds (β = −0·004; 95 % CI −0·008, −0·00009; P = 0·04). Media use during breakfast was associated with decreased HDL-cholesterol in 5–13 year olds (−0·012 mmol/l; 95 % CI −0·02, −0·004; P = 0·002), while media during lunch was associated with decreased log-TAG (−0·01 mmol/l; 95 % CI −0·03, −0·002; P = 0·03) in children aged 1–4 years. Total mealtime media use was not associated with total cholesterol, glucose or insulin in either age group.
Mealtime media use may be associated with unfavourable lipid profiles through effects on HDL-cholesterol in school-aged children but likely not in pre-schoolers.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
American black bears (Ursus americanus) are by far the most abundant species of bear, numbering more than twice that of all other bear species combined. Many US states share this history of black bear decline and resurgence, and today have burgeoning bear populations. To a large extent, the comeback of this species has been a consequence of restrictions on killing, and a fundamental change in how the public perceives and reacts to black bears. However, the success of this species is also due to its biological adaptiveness – its ability to live in a vast array of habitats, to adapt to radically variable food conditions, and to tolerate the presence of people and the changes they have imposed on the landscape. This chapter highlights the adaptability of the black bear using an extensive and diverse data set spanning 38 years. We explore reasons for their commonness, using a long-term case study from near the geographic center of this species’ range: Minnesota, USA.
To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.
The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).
Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings.
A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level “harm index” for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.
We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.
The archaeological assemblage recovered from the Middle Stone Age (MSA) levels in Blombos Cave, South Africa, is central to our understanding of the development of early modern humans. Here, we demonstrate that the cultural and technological innovations inferred from the Blombos Cave MSA record also correlate with significant shifts in site use and occupational intensity. Through a comprehensive geoarchaeological investigation of three MSA occupation phases, we identified distinct diachronic trends in the frequency of visits and the modes of occupation. During the earliest phases (ca. 88–82 ka), humans inhabited the cave for more extended periods, but cave visits were not frequent. During the later phases (ca. 77–72 ka), the cave was more regularly visited but for shorter periods each time. We argue that these changes in local occupational intensity, which also coincide with shifts in vegetation, sea levels, and subsistence, can best be explained by broader changes in hunter-gatherer mobility strategies and occupation patterns. Fundamental changes in regional settlement dynamics during Marine Oxygen Isotope Stages 5b-4 would have significantly affected the nature and frequency of social interaction within and between prehistoric populations living in the southern Cape, a scenario that ultimately may explain some of the social and technological advances that occurred there during this time frame.
To analyse nutritional and packaging characteristics of toddler-specific foods and milks in the Australian retail food environment to identify how such products fit within the Australian Dietary Guidelines (ADG) and the NOVA classification.
Cross-sectional retail audit of toddler foods and milks. On-pack product attributes were recorded. Products were categorised as (1) food or milk; (2) snack food or meal and (3) snacks sub-categorised depending on main ingredients. Products were classified as a discretionary or core food as per the ADG and level of processing according to NOVA classification.
Supermarkets and pharmacies in Australia.
A total of 154 foods and thirty-two milks were identified. Eighty percentage of foods were snacks, and 60 % of foods were classified as core foods, while 85 % were ultraprocessed (UP). Per 100 g, discretionary foods provided significantly more energy, protein, total and saturated fat, carbohydrate, total sugar and Na (P < 0·001) than core foods. Total sugars were significantly higher (P < 0·001) and Na significantly lower (P < 0·001) in minimally processed foods than in UP foods. All toddler milks (n 32) were found to have higher energy, carbohydrate and total sugar levels than full-fat cow’s milk per 100 ml. Claims and messages were present on 99 % of foods and all milks.
The majority of toddler foods available in Australia are UP snack foods and do not align with the ADG. Toddler milks, despite being UP, do align with the ADG. A strengthened regulatory approach may address this issue.
Glyphosate-resistant horseweed is difficult to manage in no-tillage crop production fields and new strategies are needed. Cover crops may provide an additional management tool but narrow establishment windows and colder growing conditions in northern climates may limit the cover crop biomass required to suppress horseweed. Field experiments were conducted in 3 site-years in Michigan to investigate the effects of two fall-planted cover crops, cereal rye and winter wheat, seeded at 67 or 135 kg ha−1, to suppress horseweed when integrated with three preplant herbicide strategies in no-tillage soybean. The preplant strategies were control (glyphosate only), preplant herbicide without residuals (glyphosate + 2,4-D), and preplant herbicide with residuals (glyphosate + 2,4-D + flumioxazin + metribuzin). Cereal rye produced 79% more biomass and provided 12% more ground cover than winter wheat in 2 site-years. Increasing seeding rate provided 41% more cover biomass in 1 site-year. Cover crops reduced horseweed density 47% to 96% and horseweed biomass by 59% to 70% compared with no cover at the time of cover crop termination. Cover crops provided no additional horseweed suppression 5 wk after soybean planting if a preplant herbicide with or without residuals was applied, but reduced horseweed biomass greater than 33% in the absence of preplant herbicides. Cover crops did not affect horseweed suppression at the time of soybean harvest or influence soybean yield. Preplant herbicide with residuals and without residuals provided at least 52% and 20% greater soybean yield compared with the control at 2 site-years, respectively. Cereal rye and winter wheat provided early-season horseweed suppression at biomass levels below 1,500 kg ha−1, lower than previously reported. This could give growers in northern climates an effective strategy for suppressing horseweed through the time of POST herbicide application while reducing selection pressure for horseweed that is resistant to more herbicide sites of action.
The effects of coronavirus disease 2019 (COVID-19) on the population's mental health and well-being are likely to be profound and long lasting.
To investigate the trajectory of mental health and well-being during the first 6 weeks of lockdown in adults in the UK.
A quota survey design and a sampling frame that permitted recruitment of a national sample was employed. Findings for waves 1 (31 March to 9 April 2020), 2 (10 April to 27 April 2020) and 3 (28 April to 11 May 2020) are reported here. A range of mental health factors was assessed: pre-existing mental health problems, suicide attempts and self-harm, suicidal ideation, depression, anxiety, defeat, entrapment, mental well-being and loneliness.
A total of 3077 adults in the UK completed the survey at wave 1. Suicidal ideation increased over time. Symptoms of anxiety, and levels of defeat and entrapment decreased across waves whereas levels of depressive symptoms did not change significantly. Positive well-being also increased. Levels of loneliness did not change significantly over waves. Subgroup analyses showed that women, young people (18–29 years), those from more socially disadvantaged backgrounds and those with pre-existing mental health problems have worse mental health outcomes during the pandemic across most factors.
The mental health and well-being of the UK adult population appears to have been affected in the initial phase of the COVID-19 pandemic. The increasing rates of suicidal thoughts across waves, especially among young adults, are concerning.
George L. Cowgill had a major influence on the study of the ancient city of Teotihuacan and the development and promotion of quantitative methods in archaeology. His wit, teaching, and research influenced many in the profession. We draw on two published autobiographical works (Cowgill 2008a, 2013a), some unpublished autobiographical notes (Cowgill 1983), his many publications, and our own associations with George.
Integrated strategies for management of glyphosate-resistant (GR) horseweed are needed to reduce reliance on herbicides. Planting a cover crop after corn or soybean harvest in the Upper Midwest may reduce horseweed establishment and growth. Experiments were conducted in Michigan to determine if cereal rye and winter wheat, seeded at 67 or 135 kg ha−1, and terminated with glyphosate at 1.27 kg ae ha−1 1 wk before planting (early termination) or 1 wk after soybean planting (planting green) would suppress establishment and growth of GR horseweed. Cover-crop biomass was 212% to 272% higher when termination was delayed by planting green compared with early termination. At the time of termination, cover crops reduced GR horseweed biomass 41% to 89% compared with no cover. Planting green increased the C:N ratio of cover-crop residue, which improved residue persistence and GR horseweed suppression at the time of POST herbicide application, approximately 5 wk after planting. Planting green reduced GR horseweed biomass 46% to 93% compared with no cover at the time of POST herbicide application; early termination provided less consistent suppression. Cover crops alone did not suppress GR horseweed through soybean harvest. Soybean yield was 30% to 108% greater when planting green compared with early termination at 2 site-years. Cereal rye and winter wheat, seeded at 67 or 135 kg ha−1, provided early-season GR horseweed suppression. Results from this research indicate that the practice of planting green may improve GR horseweed suppression through the time of POST herbicide application.
We report the effect of prospective audit and feedback (PAF) on inpatient fluoroquinolone (FQN) prescriptions. During the PAF period, FQN use decreased from 39.19 to 29.58 days of therapy per 1,000 patient days (P < .001) and appropriateness improved from 68% to 88% (P < .001). High-yield indications to target included noninfectious urinary tract and respiratory presentations.
To investigate the association between energy drink (ED) use and sleep-related disturbances in a population-based sample of young adults from the Raine Study.
Analysis of cross-sectional data obtained from self-administered questionnaires to assess ED use and sleep disturbance (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire (FOSQ-10) and the Pittsburgh Sleep Symptoms Questionnaire–Insomnia (PSSQ-I)). Regression modelling was used to estimate the effect of ED use on sleep disturbances. All models adjusted for various potential confounders.
Males and females, aged 22 years, from Raine Study Gen2–22 year follow-up.
Of the 1115 participants, 66 % were never/rare users (i.e. <once/month) of ED, 17·0 % were occasional users (i.e. >once/month to <once/week) and 17 % were frequent users (≥once/week). Compared with females, a greater proportion of males used ED occasionally (19 % v. 15 %) or frequently (24 % v. 11 %). Among females, frequent ED users experienced significantly higher symptoms of daytime sleepiness (FOSQ-10: β = 0·93, 95 % CI 0·32, 1·54, P = 0·003) and were five times more likely to experience insomnia (PSSQ-I: OR = 5·10, 95 % CI 1·81, 14·35, P = 0·002) compared with never/rare users. No significant associations were observed in males for any sleep outcomes.
We found a positive association between ED use and sleep disturbances in young adult females. Given the importance of sleep for overall health, and ever-increasing ED use, intervention strategies are needed to curb ED use in young adults, particularly females. Further research is needed to determine causation and elucidate reasons for gender-specific findings.
Adolescent girls are at risk for both macro- and micronutrient deficiencies affecting growth, maternal and child health. This study assessed the impact of an adolescent-girl-tailored nutritional education curriculum on nutritional outcomes, including knowledge, dietary behaviour, anthropometry and anaemia.
A cluster-randomised evaluation was conducted with two study arms: girls in mentor-led weekly girls’ groups receiving sexual and reproductive health and life-skills training assigned to an age-appropriate nutritional curriculum and control girls in the weekly girls’ groups without the nutritional education. The primary analysis was intent-to-treat (ITT) generalised least squares regression. Secondary analysis using two-stage, instrumental-variables estimation was also conducted.
The intervention and evaluation were conducted in urban and rural areas across four of ten provinces in Zambia.
In total, 2660 girl adolescents aged 10–19 years were interviewed in 2013 (baseline) and annually through 2017.
ITT results indicate that exposure to the nutritional educational programme did not meaningfully change outcomes for adolescents or their children. Intervention adolescents were no more likely to correctly identify healthy foods (P = 0·51) or proper infant-feeding practices (P = 0·92); were no less likely to be stunted (P = 0·30) or underweight (P = 0·87) and no less likely to be anaemic (P = 0·38). Outcomes for children of intervention participants were not improved, including being breastfed (P = 0·42), stunted (P = 0·21), wasted (P = 0·77) or anaemic (P = 0·51).
Even a high-quality nutritional educational intervention tailored to adolescents within an empowerment programme does not assure improved nutritional outcomes; adolescent preferences, resource control and household dynamics require consideration in the context of nutritional educational programmes.
Developmental origins of health and disease research have cemented relationships between the early-life environment and later risk of non-communicable diseases (NCDs). However, there is limited translation of this knowledge in developing-economy nations, such as the Cook Islands, that carry exceptionally high NCD burdens. Considering the evidence, Cook Islands leaders identified a need for increased community awareness of the importance of early-life nutrition. Using a community-based participatory research approach, this study aimed to engage Cook Islands community representatives in the co-construction of a contextually relevant early-life nutrition resource. A booklet distributed to mothers in Australia and New Zealand was used as a starting point. Ten semi-structured focus groups (n = 60) explored views regarding the existing resource and options for contextual adaptation. Three core themes were identified: knowledge of the importance of early-life nutrition, recognition of the need for an early-life nutrition resource and the importance of resources being context specific. A draft booklet was created based on these discussions. Participants were invited to give feedback via a second round of focus groups. This confirmed that the voice of the community was represented in the draft booklet. Suggestions for additional material not included in the original resource were also identified. We report on the process and outcomes of the co-construction with community representatives of a resource that has the potential to be used to stimulate community-level discussion about the importance of early-life nutrition. It is crucial that communities have an active voice in research and in making decisions about interventions for their population.